Q8 Can patients with Kallmann syndrome become fertile. ?
Without specialist treatment the majority of Kallmann syndrome patients, both males and female will be infertile. Taking hormonal replacement therapy, testosterone for the males and oestrogen and progesterone for the females will not restore fertility the the vast majority of cases.
To achieve fertility specialised treatment is required, either in the form of gonadotropin therapy (FSH and LH type treatment) or GnRH therapy. Treatment is essentially replacing either the pituitary or the hypothalamic hormones that are missing in people with Kallmann syndrome.
The success rates for these types of treatments in Kallmann syndrome patients is relatively high especially when when compared to other forms of treatment for other causes of infertility.
Examples of the types of fertility treatment available will be mentioned in another question but consideration must be given to factors that can have a negative effect on the success rate.
Male patients: cyptorchidism
The term cryptorchidism roughly translates to "hidden testes" or "concealed testes". During early development the testes are located within the abdomen and only descended into the correct location within the scrotum shortly before birth.
Cryptorchidism occurs when one or both of the testes remains lodged inside the abdomen after birth. Sometimes the testes will descend during the first year of life but often doctors suggest either using drug therapy or surgery to ensure the testes are brought down to the correct location.
If the testes are left lodged in the abdomen and not in the correct location within the scrotum there is a chance that the testes can become damaged either due to physical pressure or by the higher temperature inside the abdomen. If the testes are not located inside the scrotum by the age of 5 it will severely reduce the chances of fertility treatment working in the future.
If a man with Kallmann syndrome never had cryptorchidism or it was corrected within the first 5 years of life there is a good chance fertility treatments will be successful later in life. Even if the testes have been small and dormant for a long time they can still be stimulated into activity given the correct treatment and enough time for the treatment to work.
Therefore, if you have never been cryptorchid, there is a fair chance that your fertility treatment will prove successful.
All patients: Availability & cost of treatment:
Fertility treatments, while potentially successful can be expensive and can require specialist medical advise for their prescription and use.
Male infertility treatments have the additional problem that it can take up to 24 months of treatment in order to achieve sufficient sperm production to allow for natural or assisted conception.
Patients often have problem getting hold of the treatments due to budget restrictions from health services or insurance companies. Knowing which medications are likely to the be most effective and seeking the advise of clinicians experienced in treating Kallmann syndrome patients is often essential for fertility treatments.
Often women with Kallmann syndrome are seen by their local general doctor or obstetrician. However when it comes to fertility treatments it is often helpful to seek the advice of a reproductive endocrinologist as well.